Healthcare Provider Details

I. General information

NPI: 1790427466
Provider Name (Legal Business Name): CRISTIAL LOURDES SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BRADBURY DR SE
ALBUQUERQUE NM
87106-4374
US

IV. Provider business mailing address

933 BRADBURY DR SE
ALBUQUERQUE NM
87106-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3120
  • Fax: 505-818-8060
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-818-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: